What is pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is an infection that can affect your uterus (womb), ovaries and fallopian tubes. If you have PID and it goes untreated, it can lead to blockages or "adhesions". Adhesions are where tissues become stuck together, something that can cause fertility problems if it happens around your fallopian tubes.

How will I know if I have PID?

You may have only mild symptoms of discomfort or be unaware of it. Look out for:

unusual vaginal bleeding, such as heavy bleeding, bleeding after sex or spotting between periods

yellow, green or smelly vaginal discharge

pain in your back passage

(NHS Choices 2010)

If you have had an ectopic pregnancy (where the fertilised egg implants outside the uterus), the cause may have been PID.

A severe PID infection may lead to:

pus-filled abscesses developing in the ovaries and fallopian tubes

inflammation of the thin layer of tissue that lines the inside of your abdomen (peritonitis)

fever, nausea and vomiting (NHS Choices 2010, RCOG 2008)

If your infection is as severe at this, you will need to be admitted to hospital.

Will having PID affect my fertility?

If PID is mild and treated early, your chances of being able to get pregnant are high. One episode of PID is unlikely to affect your fertility (NHS Choices 2010).

If you have severe PID or your PID goes untreated, the chances of your tubes becoming blocked are higher (BASHH 2011, NHS Choices 2010). Repeated episodes of PID greatly increase your risk of not being able to get pregnant (BASHH 2011, RCOG 2008).

It's estimated that one in five women with PID have fertility problems (NHS Choices 2010). Damage to the fallopian tubes as a result of PID also increases the risk of an ectopic pregnancy (RCOG 2008).

What causes PID?

It's likely that your PID has been caused by a sexually transmitted infection (STI). The infection has spread up through the opening to your uterus (cervix) to infect the rest of your uterus, and your fallopian tubes and ovaries.

Chlamydia is the infection most often to blame, followed by gonorrhoea and other STIs (BASHH 2011). If you have chlamydia, there's up to a one in three chance that you'll develop PID (PRODIGY 2009).

Your chances of developing PID increase if you:

have sex without a condom

are under 25, as chlamydia is common in young people

become sexually active at a young age

have a new sexual partner

have multiple sexual partners

have a history of STIs, or your partner does(PRODIGY 2009)

Sometimes, PID can damage your cervix, making it more likely that you'll have a repeat infection (NHS Choices 2010).

How is PID diagnosed?

It is likely that your doctor will refer you to your nearest genito-urinary medicine (GUM) clinic for tests. Clinic staff can take swabs from your vagina and cervix to look for possible STIs, such as chlamydia. You may also have blood tests. The swabs and blood tests will be sent to a laboratory for testing. It may be suggested that you have an ultrasound scan, too (RCOG 2008, 2010).

Your GP can carry out some of these investigations and tests. But a more comprehensive service is offered by a GUM clinic. Find numbers for GUM clinics from the Family Planning Association.

How is PID treated?

PID is treated with antibiotics. Even if your doctor is not completely sure you have PID, it is safer to treat you. Any delay in treatment risks damage to your fallopian tubes and ovaries, and your long-term health (BASHH 2011,RCOG 2008). You and your partner will both need to take antibiotics, to make sure he doesn't re-infect you.

Your doctor should prescribe a combination of antibiotics to make sure that all the bacterial infections that commonly cause PID are treated (BASHH 2011).

Your doctor is likely to advise you to get some rest and take painkillers. She'll advise you to be sure you complete your course of antibiotics, which may last two weeks (BASHH 2011). To prevent re-infection, you shouldn't have sex, including oral and anal sex, until you and your partner have completed the course of treatment.

Your doctor may want to see you again within a few days of starting antibiotics, to make sure that the treatment is working. You'll have another check-up a few weeks after that to confirm that the infection has cleared (BASHH 2011, RCOG 2008).

I've had PID. What fertility treatments can I have?

First, any damage to your fallopian tubes has to be assessed. You may be offered a minor surgical investigation called a laparoscopy. You will have a general anaesthetic, so you will be asleep throughout the laparoscopy. The procedure involves your doctor making a small cut just below your navel. Through the cut, she'll insert a tube carrying a tiny camera to view inside your pelvic area.

Your doctor will be able to have a good look at your fallopian tubes and any scarring, blockages or adhesions. You should also be offered a "lap and dye" test, where a coloured dye is injected into your fallopian tubes to check for blockages and other problems (NCCWCH 2013:107).

IVF is now a more popular treatment for tubal disease than having surgery, and the same IVF success rates apply as with its use for other fertility problems (NCCWCH 2013:131).

If you opt for tubal surgery, you have about a one in four chance of conceiving within about a year (NCCWCH 2013:183). Most pregnancies occur between 12 months and 14 months after tubal surgery and, if your PID was mild, you may get pregnant even sooner (NCCWCH 2013:184).

It's worth carrying on trying to conceive naturally after this time, if your PID was mild to moderate, as the pregnancy rate by three years can be as high as 50 per cent to 67 per cent, depending on the serverity of the disease (NCCWCH 2013:183). However, if you haven't conceived by 18 months, your fertility specialist may suggest IVF (NCCWCH 2013:183).

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